INTRODUCTION
The expanding use of bone marrow transplantation (BMT) and intensive
chemotherapy in the treatment of children with hematologic and oncologic
disease has placed them at an increased risk for opportunistic
infections such as acute invasive fungal rhinosinusitis (AIFR), a life
threatening infection1,2.
The diagnosis of AIFR is challenging owing to the often-nonspecific
presenting symptoms3. The disease has a rapidly
progressive course, and timely diagnosis and detection of the fungal
pathogens is crucial for successful management and clinical outcome of
patients4. Direct microscopy and histopathology are
the gold standard for diagnosis5. Cultures are used to
identify the culprit agents and their antimicrobial susceptibility.
Since the late 1990s more rapid and sensitive detection methods, such as
in-situ hybridization and polymerase chain reaction (PCR), have been
applied. Nevertheless, the detection spectrum of real-time PCR has been
mostly restricted to a variety of Candida or Aspergillusspecies6.
In recent years, new panfungal PCR assays have been developed in order
to detect a wider range of fungal pathogens7,8. The
use of panfungal PCR assay in addition to histopathology and cultures
seems to contribute to higher detection rates in cases of
AIFR4. Additionally, the introduction of novel
antifungal drugs such as posaconazole and isavuconazole may improve
patients survival rates9,10. Finally, timely surgical
debridement, a cornerstone of the management of AIFR, has been shown to
be an independent prognostic factor in the survival of
patients11,12. Improved endoscopic surgical skills
using advanced instrumentation, high-definition cameras and
intraoperative stereotactic navigation may lead to better survival
outcomes in the management of children with AIFR13.